BHARAT SANCHAR NIGAM LIMITED

(A Govt of India Enterprise)

APPLICATION FORM FOR NEW MOBILE CONNECTION

Mobile Number

Affix self signed passport size photograph

CAF / Ware house Serial Number

SSA _____________

Type of Connection (tick appropriate box) *

Pre-paid

Post-Paid

1.Name of the Subscriber/Organisation * (As given in Proof of identity document attached with application):

2. Name of Father/Husband/Authorised person * (As given in Proof of identity document attached with application):

3. Gender * : -

Male

Female

4. Date of Birth* (DD/MM/YYYY)-

5. Complete Local residential Address*/ Subscription Address* (As given in proof of Address document attached with application): House No/Flat No* Locality / Tehsil *______________ City/District* Pin Code* :6. Complete permanent residential Address of subscriber: House No/Flat No Locality / Tehsil ______________ Pin Code :7. Bill to be sent to (please tick)
5

Street Address/Village* State/UT*

Street Address/Village City/District State/UT

or

or any other address

8. Status of Subscriber* : - Individual Tick appropriate box Government 9. PSU BSNL Employee

Bulk

Corporate
Others

Foreigner

Outstation

Test SIM

Nationality *________________________________ 10. E-mail address (if any)_______________________@_______________

11. Photo ID Proof document type* (Driving License/voter ID Card/Passport/PAN card/Adhaar/other specify): Document No.*__________________________________________ Date of Issue* ______________________________________ Place of Issue* _________________________________________Issuing Authority *____________________________________ 12. Address proof document type* (Driving License/Voter ID card/Passport/Adhaar/Other (specify) :_____________________________ Document No.* ___________________________________ Date of Issue* _____________________________________________ Place of Issue* ________________________Issuing Authority* ______________________________________________________ 13. Number of Mobile connections held in name of Applicant (Operator-wise)* :Name of operator Numbers held Name of operator Numbers held ______________ ____________ ______________ ______________ ______________ ____________ ______________ ______________ ______________ ____________ ______________ ______________ ______________ ____________ ______________ ______________ 14. Services/Facilities required:- 3G Tick appropriate box

Call transfer

STD

ISD

GPRS/MMS

National Roaming

International Roaming

Navigation

Itemized Billing

Others (please specify) _________________________

15. Tariff Plan Applied* (Please see tariff card) __________________ 16. Value Added Service Applied (if any) ____________________ 17. Tariff Plan Opted for GPRS/MMS (Please see tariff card) _____________________________ 18. Alternate Contact numbers, if any; Home: _________________________Business_________________ Mobile________________ 19. Profession of Subscriber: _________________________ 20. PAN/GIR/UID Number: 21. Details of Local reference* (if Applicable in case of outstation customer): Name ______________________________________ Address _____________________________________________________________Phone number ________________________ 22. To be filled in cases of Mobile Number Portability (Separate form for MNP is also to be filled) :(A) UPC_________ (B) Previous Service Provider Details: ____________(C) Mobile No. to be ported in_____________________

www.bsnl.co.in

TERMS AND CONDITIONS

An agreement is formed between the customer named overleaf (hereinafter referred to as the Customer) and Bharat Sanchar Nigam 4.8 The Customer must pay call charges in respect of all calls made/received during the Agreement Period from/to his/her mobile Limited (hereinafter referred to as BSNL) a company registered under the Companies Act 1956, having its registered office and Corporate number and/or SIM - whether or not authorised by the Customer and whether or not they exceed any credit limit, if any, agreed between Office at Bharart Sanchar Bhawan, Harish Chander Mathur Lane Janpath , New Delhi-110001, and Local Office at Plot no. 2, sector-34A, BSNL and the Customer. This equally applies to all other tariff payments. Chandigarh, when the form overleaf or some other form or order (e.g. mail order, Fax etc.) has been signed/sent by or on behalf of the 4.9 The loss of or inability to use the Customer Equipment or a SIM does not bring the Agreement or the Customer's Liability to pay Customer and BSNL has accepted the same, when used in these conditions. Customer EquipmentMeans GSM mobile telephone equipment described in the Agreement. charges to an end. 4.10 Where a security deposit has been paid, BSNL is entitled to retain it and apply it as it decides in full or partial satisfaction of any NetworkMeans the BSNL GSM Network. sums due from the Customer to BSNL any time. At the end of the Agreement period, provided all sums payable to BSNL have been duly Services Means the services, which enable the Customer when using the equipment to have two-way communication over the network paid, the balance (if any) of the deposit or fee will be repaid to the Customer on fulfillment of such conditions as may be intimated by and includes other value added/supplementary Services offered by BSNL and specifically, opted by the Customer. BSNL. No interest will be paid on the deposit. BSNL reserves the right to adjust the security deposit of the BSNL connection of one member of a family against the bill of the other BSNL connection(s) issued by other family member(s). Tariff Means and includes the agreed Tariff schedule and all rate and related conditions such as deposits, installation fees, rental, usage charges and any other related fees and service charges under the Tariff schedule as notified and published by BSNL from time to 4.11 The call pulse rate shall be governed by the rules and regulations as specified by the Regulatory Authorities from time to time time for providing the services and value added/supplementary services. and/or specifically specified by BSNL. SIM Means a Customer Identification Module being a card or microchip programmed with data, which is used to gain access to the network. 4.12 Itemized monthly bills are available on request and are chargeable in nature at such rate as may be decided by BSNL from time to time. CustomerMeans a person/company/firm/or any other association of persons who has subscribed for services under this agreement. 5. PENAL CHARGES FOR DELAYED PAYMENT: This agreement binds the customer and whenever & wherever applicable, his heirs, executers, administrators, successors and permitted 5.1 The payment against monthly bills beyond the stipulated date shall entail an interest charges @ 2% p.m. or such other rate / fixed assigns and benefits BSNL its successors and assigns. amount as may be decided by BSNL from time to time, over the payment from the date it became due. This however is without prejudice Bulk Mobile ConnectionMeans 10 or more than 10 mobile connections issued in a single name to individual or a company or an to the rights of BSNL to suspend the services partially or fully due to non-payment. organization or at any given address by all the License service providers in the service area. 6. SUSPENSION AND DISCONNECTION 6.1 BSNL may at any time suspend, without notice and without my liability, the Services wholly or partially and/or disconnect any 1.PERIOD OF AGREEMENT 1.1 The Agreement period shall run in concurrence with Licence Agreement between the Department of Telecommunications, Ministry Customer Equipment from the Network for any reason which is found to be reasonable by BSNL including any of the following of Communications, Government of India and BSNL for the operation of Cellular Mobile Telephones Service in the concerned licensed circumstances. geographical areas & shall be subject to all applicable laws, byelaws, rules, regulation, notifications, orders, directions of the a) Due to any discrepancy noted in the material particulars provided in the Form overleaf including address confirmation. Government / Court / Tribunal and shall be subject to other terms of the Agreement. b) The non-payment of bills beyond the due date. The BSNL reserves the right to totally or partially disconnect the Customer in case 2. COMMENCEMENT of non-payment of the due bill by the due date or in case the cheque is dishonored. Although no notice is mandatory, call warning 2.1 The customer shall ensure that he/she/it will duty fill and sign the form overleaf and all other required forms, besides furnishing other or an SMS message notified to the customer on his mobile number or any other verbal or written communication shall be construed particulars/documents for identification as required by BSNL / Govt. of India from time to time become eligible for subscribing to the said as due notice in this regard. Services rendered by BSNL. In the event of any default, on the part of customer as stated above, BSNL shall be well within its right to refuse c) During Technical failures, modification or repair or testing of the Network. the connection without any liability of the said customer to its network and even to disconnect the same in case the said customer is d) BSNL reserves the right to totally or partially disconnect the Customer connection or to put him on Local calling facility or only already connected to the network and to forfeit the balance, if any, available on the card of the said customer and the same shall neither incoming call facility with or without notifying him in the case of his exceeding the prescribed credit Limit BSNL does not however, be credited nor refunded under any circumstance(s). guarantee to effect such suspension/disconnection immediately upon the customer reaching the credit limit. The BSNL has the right 2.2 For proof of address customer has to submit along with form overleaf, self attested copy of any one of Electricity Bill / Water Bill / Ration to predetermine and prefix the credit limit to usage of Air Time Services, PSTN services and other Value Added Services. In the event Card / Passport / Telephone Bill / Voter ID Card / Driving License/Adhaar or any other document as prescribed by the Deptt of Telecom/BSNL from time to time of the Customer having exceeded his predetermined limit he will be responsible to pay for all the calls made and services obtained 2.3 For Proof of Photo Identity the customer shall submit along with form overleaf self attested copy of the (a) Photo Identity Card issued even beyond the stated limit. by Government or Statuary Authority / Photo Credit Card / Drivinig Licence / Income Tax PAN / Passport / Arms License / Voter ID Card / e) When this Agreement is determined owing to any reason in consonance with the terms of this Agreement. Adhaar or any other document as prescribed by the Deptt of Telecom/BSNL from time to time (b) Public Limited Company may enclose f) Any other reason which is found to be reasonable by BSNL warranting suspension / disconnection. certificate of incorporation along with any proof of identity, as indicated at (a) above of the authorised officer of the Company (c) In case 7. LIABILITY of Government of India Undertakings, Government of India Officers/State Government Offices, the aforesaid requirements are dispensed 7.1 BSNL will not be liable to the Customer for any loss of business, profit, revenue or goodwill, anticipated savings, use or contracts or with and self-certification on the letterhead will suffice along with the name and designation of the coordinating officer to be consulted for any indirect or consequential loss how so ever it arises. in case of need (d) In case of Foreign Missions in India and other Foreign Agencies, the name and designation of the authorized officer 7.2 BSNL shall not be liable for any delayed activations. along with details of officials etc. are required for whom the Cellular Mobile Phone is intended. 7.3 BSNL will not be liable for any dealings of the Customer with any party, which is not authorized by BSNL to deal on its behalf. 2.4 In case of outstation customers, details of local reference are required to be given. 2.5 (a) For sole proprietary concern, proprietor may sign himself and affix rubber stamp on the form overleaf (b) In case of partnership 7.4 BSNL makes no express or implied warrantees, guarantees, representations, or undertaking whatsoever, regarding the service, equipment etc. which are not expressly mentioned in this Agreement and shall not be liable to the customer and / or any person, concern, all partners or any one of the partners duly authorized or Person with the Power of Attorney may sign. (c) In case of Company, firm or body corporate claiming through, under or in trust for the customer and the customer hereby waives and agrees to continue signature should be of a person on behalf of a Company, in accordance with the provisions of its Articles of Association. In case of waiving all claims / actions for any delays, loss, damages, fee, costs orders judgment etc. direct / incidental or consequential arising partnership concerns, copy of (i) Power of attorney for authorization & (ii) Partnership Deed and In case of Company, a copy of the Articles of Association, is to be attached. out of any mistake, omission, interruption delays errors, defects or other failure with respect to the service / equipment or billing 2.6 If at any stage information furnished in the form overleaf is found false - Telecom Service / Telephone provided is liable to be arrangements, payments or collection and or matters covered in clause 3.5 hereof etc. and or matters related to this agreement. disconnected immediately without any notice. Further the customer remains solely responsible to his own negligence acts or omission. 2.7 Agreement commences upon BSNL activating the SIM card and continues subject to other terms, as per plan(s) / Scheme(s) / 7.5 BSNL will not be under any liability for the Cellular Mobile Services under this Agreement or for any failure to carry out its duties and Services(s) chosen by customer and operate concurrently with BSNL license to provide services. Any moneys paid by the Customer shall obligations outside the BSNL's control such as atmospheric conditions, physical features (e.g. bridges and buildings) and the proximity not create any right in favour of of the base stations, Acts of God etc. and any other force majeure conditions due to which the services are affected. customer until activation. In addition, BSNL reserves the right to seek/verify financial and the other information from customer's Bankers/Credit providers and such other sources and reserves the right to reject subscription even after activation for any reason without 7.6 BSNL is not responsible for the acts of Franchisees / Business Associates / Distributors / Channel Partners / Dealers / Retailers with regard to schemes which are not authorized by BSNL or which are purported to have been offered on behalf of BSNL without the latter's liability. 2.8 Customer represents that he has been fully informed about the Cellular Mobile Telephone Services provided by BSNL, its sanction. specifications, requirements, limitations, tariffs etc. and has only thereupon signed this agreement. 7.7 A SIM is provided for the Customer's use in order to gain access to GSM network. It is the Customer's responsibility to keep these 2.9 BSNL shall be at liberty to provide the services under any brand name. secure as BSNL is not liable for any loss or liability incurred by the Customer resulting from the unauthorized use. In case of loss of SIM 2.10 The information provided by customer / gathered by BSNL shall become BSNL's property even if application is rejected / refunded card by the customer, the same should be reported to BSNL at the earliest. The issuance of new SIM card shall entail charges as set out or connection is disconnected as the case may be and can be used by BSNL in any manner, if deemed fit. in the Tariff schedule from time to time. 2.11 Bulk mobile connections shall not be provided to individual. 2.12 The number of mobile connections used by the bulk user from other licensees in that Service Area shall be declared by the bulk 7.8 The SIM card remains the constructive property of BSNL in the hand of the customer. The same shall be returnable of BSNL on user at the time of filling the CAF. In addition to declaration of all his connections by the customers, the licensee can also verify from Severance/Suspension of customer relationship for any reason whatsoever as per items & conditions BSNL is not responsible for any its records the details of existing connections working in the name of the same subscriber before activation of new SIM. manufacturing defect in SIM card after an expiry of 6 months from the date of purchase. Beyond this period, customer will have to 2.13 The licensees shall maintain the list of actual users of such mobile connections. In case there is change in the actual user, the same obtain a new SIM card after paying the requisite charges in case of any defect in SIM card shall be informed by the bulk user Authorized Signatory to the Licensee within a week of such change. The Licensee shall update its 7.9 The customer hereby agrees to indemnify and hold BSNL harmless against any claim against BSNL for libel or slander arising out of database immediately but not later than one week of receiving such information. Record of such changes in actual users shall be communications sent or received by Customer on BSNL's Network. The Customer shall also indemnify BSNL for any claim against BSNL kept by the Licensee. The list of users with name and designation duly signed with stamp of authorized signatory (on each page of arising out of any infringement or violation of copyright by the Customer or by anyone else using the mobile connection of the Customer. list) shall be maintained by the Licensee. The authorized signatory shall at the end of three months summarise the change of name taken place during the month. In case there is no change, a certificate mentioning no change shall be given to Licensee.2.14The 7.10 BSNL shall not be responsible for any civil or criminal liability incurred by the Customer due to its misuse of the Service provided change of name of subscriber is not permitted as the SIM card in user terminal is not transferable. The change in name between the by BSNL i.e. any acts of commission or omission by the Customer. blood relatives/legal heirs is permitted provided new CAF and all the procedure as for registering a new subscriber is followed and 7.11 BSNL shall not be liable for any act of commission or omission of any third party/suppliers/manufacturers/including any agency/ new SIM Card is issued. However, after the change in name the connection shall be treated as new connection. In such case, change company offering any privilege or benefits to Customer without specific permission or authority of BSNL. in address is not permitted. Further, No Objection Certificate from the original user shall also be taken. In case of death of the 7.12 BSNL reserves the right to terminate the subscription of any customer who is not competent to enter into any contract under the original user, death certificate will suffice instead of No objection Certificate. Indian Contract Act, 1872. 2.14 All the mobile subscribers either individual or bulk should intimate to their service provider, any change of address within one week of such change alongwith new proof of address. If during re-verification process by the Licensee or Licensor or Security 7.13 Any increase/addition/introduction of taxes and/or levy of any taxes, duties or any other statutory charges etc. (present/future) shall be to the customer's account without any notice to hime and shall at all times be deemed to be part of tariff. Agencies, it is found that subscriber address is not correct in the database, then the connection may be disconnected forth with and the subscriber shall be solely responsible of any consequent hardship. 7.14 Customer will provide to BSNL all information and co-operation that BSNL may reasonably require from time to time. 2.15 In cases where forged documents are submitted by the subscriber and originals are also forged police complaint/ FIR shall be 8. SALE OR TRANSFER lodged by the PoS/Franchisee/BSNL/DoT/Security agencies against the subscriber as and when the forgery is deceted. 8.1 BSNL connection/SIM card shall be non-transferable in nature and any private transfers effected by the Customer shall not absolve 3. SERVICES the Customer of his primary duty towards BSNL for usage charges levied pertaining to such particular connections/SIM card. 3.1 The customer shall be provided a SIM card along with PIN (Customer's Security Code), and a personalized Telephone Number which can be changed by BSNL at any time) to enable the customer to use BSNL services upon acceptance, within BSNL System 8.2 BSNL's acceptance of Payment from a person other than the Customer shall not amount BSNL having transferred or modified any of rights & obligations to the customer to such third parties. operating range in the licensed geographical areas.. 3.2 The SIM card and personalized Telephone Number is and shall always to be the sole property of BSNL and shall be returned by 9. DISPUTE RESOLUTION customer(s) upon termination/determination, hereof, and/or temporary suspension of services. 9.1 In case of any dispute, the matter will be referred to the sole arbitration of Chief General Manager Telecom, BSNL of the concerned 3.3 For change/addition/deletion of any features/supplementary services/scheme/plan, customer shall fill up the requisite form and area or his nominee and will be governed as under Provisions of the Arbitration and conciliation Act, 1996 or any statutory modification by bound by the additional terms thereof. Any change or withdrawal from any supplementary services etc. shall not entitle the or reenactment there of or any rules made thereof, customer will have No objection in any such appointment that arbitrator so customer to any refunds or adjustments of the moneys already paid, billed or to be billed under the additional terms. appointed is employee of the BSNL. 3.4 Customer cannot use the service for any unlawful or illegal purposes or immoral, improper or abusive purpose or for sending 10. ENDING THE AGREEMENT obscene, indecent, threatening, harassing, unsolicited messages, or messages affecting/infringing national interest nor create and damage or risk to BSNL or its network and/or other customers which relates to the network the service equipment or connected 10.1 Except as provided elsewhere either party may end the Agreement by written notice giving not less than 30 days to other party but such a notice shall not absolve the customer of its liability to make payments of the amounts that may be due and outstanding on matters. BSNL reserves the right to disconnect service, without liability, if any, at its sole discretion on any such event. the date of such notice or as may become due subsequently. 3.5 Service quality, functionality, availability and/or reliability may be affected and/or BSNL is entitled to, without any liability, refuse, limit, suspend, vary, disconnect and/or interrupt the service, in whole or in part at any time, at its sole discretion, with respect to 11. OTHER MATTERS one/all customer(s) without any notice, for any reason and/or due to various factors including but not limited to: (a) Government's, 11.1 Where two or more persons constitute the Customer, their liability is joint and several. TRAI's rules, regulations, orders, directions, notifications etc. including changes thereto (b) Transmission limitations caused by 11.2 This agreement is amenable to the jurisdiction of Courts at the only location of office of Chief General Manager Telecom, BSNL of the topographical, geographical, atmospheric, hydrological and/or mechanical conditions. (c) During technical failure, modification, up area concerned & laws of India. gradation or variation, relocation, repair and / or maintenance of the systems / equipments (d) To combat potential fraud, sabotage, 11.3 The scope of the cellular services is governed by the Statutory Guidelines issued by the Telecom Regulatory Authorities & Govt. of India willful destruction, etc. (e) If services is used in any manner, which violates any law etc. or adversely affects or interferes, in any within the parameters of License Agreement executed with Ministry of Communications, Govt. of India. The cellular phone services manner, the rendering of services of BSNL. (f) Any discrepancy/wrong particular(s) provided by the customer in the form overleaf. are governed by the Telegraph Act, 1885 and the Indian Telegraph Rules, 1951 framed under the same act, as amended from time to (g) Breach of any term or conditions of this agreement on the part of the customer. (h) If rendering of service providers. (i) Any time and the customer shall abide by them. other reasons, which is found to be reasonable by BSNL warranting suspension/disconnection. (j) Force- majeure circumstances 11. 4 All discounts or other special benefits announced by BSNL from time to time shall have the time limitation, BSNL shall have the (i.e. Acts of God). (k) Delay / non-payment of bills, (l) Incompatibility with equipments including customer Equipment. right to withdraw / vary / extend any / all such discounts etc. at any time without notice. 3.6 Privacy of communication is not guaranteed and is suject to Government's Regulation and such other factors. BSNL is entitled to change, vary, add and withdraw any services/supplementary Services/ Schemes/Plans etc. and/or to vary the terms and charges at 12. IMPORTANT any time, at its sole discretion. The rates/ charges may also change as per the directives of TRAI or any statutory authority from 12.1 Peak, standard, and off-peak hours may differ from one operator to another. time to time. 3.7 In case of expiry/deactivation, the cellular number may be allotted to another customer as per the sole discretion of BSNL. In that 12.2 The information provided overleaf shall be treated as part & parcel of this Agreement. event, the customer shall not have any right or lien on the said cellular number. In case of suspension / disconnection etc. 12.3 Monthly statement of charges would reflect only consolidated call charges for roaming calls and no bifurcation of airtime and reconnection may be made by BSNL in its sole discretion, on such additional terms as BSNL may determine. landline charges would be available. 4. BILLING AND PAYMENT 12.4 While roaming, all incoming call will be charged at STD/ISD rates, as applicable plus the incoming airtime at the location being visited. 4.1 The Billing cycle shall normally run on monthly basis or such other frequency as may be decided by BSNL from time to time and the periodic bills be issued accordingly. The Customer is responsible to pay his bills by the prescribed date. It is incumbent on the 12.5 A service tax as applicable shall be levied on all charges payable by the customer. Customer to enquire for his/her balance and settle the same even in case of non-receipt of the monthly bill for any reason whatsoever. 12.6 The customer has understood that depending upon different services / plans chosen by various customers, the prices / charges, 4.2 BSNL reserves the right to raise interim bills and the Customer agrees to make such interim payments as & when required by BSNL, fee etc. applicable hereto may also be different. based on internal credit rating of BSNL. 13. EQUIPMENTS 4.3 Bills will be sent to the billing address of the Customer as furnished by him/her. For any change of address the Billing department 13.1 BSNL will test the equipment prior to activation & customer shall ensure its functionalities BSNL shall not be responsible for any of the should receive notification in writing well in advance to change the address along with such proof to accept the change. defect / fault etc. which is not expressly covered by the manufacture warranty of the equipment. Any repairs / exchange carried out 4.4 In case any charges are disputed, customer shall intimate BSNL within 2 days of the receipt of billls. In case of non receipt of such information the charges will be presumed to have been accepted. Customer shall have to pay full amount of even disputed charges by BSNL at the request of customer for defects etc. shall be charged from the customer as per BSNL policy on the subject from pending settlement of disputes. time to time. 4.5 The Customer agrees to pay to BSNL the subscription charges, opted, value added service charges, supplementary service charges, BSNL charges for calls made from mobile to fixed network, monthly rental, NSD/ISD Charges, Service Tax, License Fee other taxes & 14. AMENDMENT TO AGREEMENT duties etc. and other charges payable for the services as published and notified by BSNL as per tariff applicable from time to time. 14.1 BSNL only may amend any part of this Agreement at any time by giving Customer prior notice. Customer's continued use of service or 4.6 All charges and other sums to be paid by the Customer are due for payment by prescribed due date. All charges must be paid in full payment of any dues / bills after BSNL's has issued such amendment will constitute customer's agreement to all amedments. without any deduction, set-off withholding. All payments must be made in favour of AO (Cash), BSNL, of the concerned area. I confirm and I have read the terms & conditions and I agree to abide by them. 4.7 The present rate of deposits, connection charges, monthly rental charges, call charges and other payable charges are set out in the Tariff Schedule as notified by BSNL. BSNL shall have the option to vary the tariff, charges for value added services, supplementary (Signature of Customer) services and any other conditions of services, retrospectively or from future date and the same shall be binding on the Customer.

BHARAT SANCHAR NIGAM LIMITED

(A Govt of India Enterprise)

23.To be filled in case of Post-paid connection:(A) Form of payment Cash Cheque

(Tick appropriate box)

Credit card

Debit card

Bank Draft

(B) If payment made by cash/cheque/credit card/debit card:- (a) Bank A/c No. ______________________________ (b) Bank Name ______________________(c) Branch Name & Address _________________________________ (C) Credit limit opted Rs___________ (D) Amount of Payment Made : __________________
I/We hereby declare that information given above is true to the best of my knowledge. I/We will abide by the prevailing Telegraph Act/Rules framed there under and tariffs as amended from time to time. I/We am/are not a defaulter on account of non-payment of bills for any telecom services provided by any service provider. I/We have read and understood the terms and conditions for cellular services and accept them as binding on me/us. I/We have understood all rates, charges and related terms and conditions at which telecom services are provided by BSNL as applicable on this date and as amended from time to time. I/We confirm that the information / particulars supplied by me/us is correct in all respects. I/We declare that in case of roaming abroad my usage amount will not exceed the limit prescribed by FEMA regulation. I/We understand that the connection/SIM is non transferable. Any misuse of connection/SIM by customer or any other person is illegal and liable for criminal action.

Date*:- _________________

Signature of Customer*/Authorised Signatory*

( For Office Use Only ) Fields to be filled by Service provider/Authorized representative at Point of Sale
24. IMSI No.*/SIM Card No 26. Category: Urban Rural 28. Point of sale agent name* : - _______________________ 25. Mobile number attached*

27. Point of sale code* : 29. Complete Address of Point of Sale* :-

House No/Flat No ________________________ Street Address/Village ______________________________________________ Locality / Tehsil ______________________ City / District_________________ State/UT________________ Pin Code _____________ 30. (a) Declaration by POS* :Certified that I have seen the subscriber and matched the photograph attached on the CAF with the subscriber and verified his copies of documents of POA and POI attached with the CAF with the original. (b) Declaration by POS in case of outstation subscriber* :Certified that the local reference Shri/Smt* ___________________________ has been contacted telephonically. Name* _________________Stamp* 31. Declaration by the franchisee / BSNL Staff It is certified that I have checked the form as per the DOT guidelines and entered the subscriber details correctly in the BSNL Database Name of franchisee/BSNL staff* _____________ Stamp* Signature*___________________Date*_____________ Signature*______________ Date*_____________

Fields to be filled by Employee of Service Provider before SIM Activation

32. (a) Certified that all the documentary requirement has been completed and subscriber details are uploaded in the database before activation of the SIM*. (b) Certified that the local reference (in case of outstation subscriber ) Shri/Smt* _________________________ has been contacted telephonically*. (c) Details of Add-on/Value Added facilities like 3G Others 33. 34. Call transfer facility ISD facility GPRS Navigation (Please specify) ________________________________________

Tariff plan(s) etc. activated on the SIM Card ______________________________________________________________ Initial activation done on date*_________________________________________ Final activation done after tele verification on date*________________________ Name* ____________________________ Designation* _________________ Signature*___________________ Date* ___________________ *Mandatory Fields - These fields are mandatory to be filled.

Subscriber Receipt
BSNL CAF Serial Number Name of subscriber*_____________________________________Mobile number applied for* _________________________________ Type of POI* __________________ Issuing authority*________________ Date of issue* __________Serial Number*_______________ Type of POA* __________________Issuing authority*________________ Date of issue* __________Serial Number* ______________

Received with thanks an amount of Rs.___________________ by Cash/Draft/Cheque No________________ Dated _____________ Issued from ________________bank _____________________city. Name of POS* _________________ Stamp* Note: Signature*_________________Date*____________

For activation of Sim, Please dial 1507 in 1-2 days for tele verification.